With Physicians On The Front Lines, Report Recommends Changes For Chronic Pain Treatment

A new research paper
shows doctors in Vermont are feeling the stress of being on the front lines of
the fight against prescription drug abuse.

The report lays out several
recommendations - including changing insurance policies so that non-drug
therapies are covered.

The research effort for the
Vermont Medical Society Foundation was led by Dr. Cy Jordan, a former primary
care physician. He says he heard time and again in more than 30 interviews that
practitioners struggle to treat their patients' chronic pain while also trying
to avoid prescription drug abuse.

"The physicians and the
dentists and the prescribers find themselves between this rock and a hard place
of wanting to offer care and help people - I mean, that's their job - at the
same time being scammed and taken advantage of," he says. "So they're very
frustrated."

Pain treatment now includes a
class of extremely powerful synthetic opiate drugs. The drugs can be legally
prescribed but then are sometimes sold on the street. The report includes a
startling statement from the state medical examiner that about one Vermonter a
week dies from a recreational drug overdose.

"These medications are much more
addicting," Jordan says. "There's a bigger downside than was thought in
the medical community. And there's a higher awareness of that now."

The report makes several recommendations,
both for the medical community and for policy makers in general.

For physicians, the report
suggests a single set of guidelines or standards for treating chronic pain.

Dr. Zail Berry is a palliative medicine specialist who also teaches
at the University of Vermont College of Medicine. She says the standards would
help practitioners who may not have much experience treating pain.

"This is one of things I've
been thinking for a long time would be really great, because I'm teaching at
the university and trying to convince students and residents to use appropriate
principles," she says. "To have something very standardized, that is sort of
sanctioned that everybody can feel comfortable about using would be just be a
great tool... I don't see the argument
against it."

The report also says the
state's prescription drug monitoring data base can be improved. The system
allows physicians to see if a patient has multiple pain prescriptions from
multiple doctors - a warning flag for abuse and doctor shopping.

Physicians reported that the
data base is very valuable. Cy Jordan says the system would be even more useful if it was
updated more frequently.

"The uploads are only on a
weekly basis, and yet out here in the community things happen really fast,
particularly when you have people scamming and gaming the system," he says.

The report also takes aim at
insurance companies' reimbursement policies. Jordan says insurance carriers will readily cover pain
medication, but not treatments involving human touch that are more effective in
the long run.

"The way we pay for pain
treatment now, it encourages the use of opioids. It does not encourage the use
of alternative non-medications, that actually there's more research supporting
physical therapy even massage," he says. "There is no research to show that
Oxycontin and Percocet work for chronic pain."

Jordan hopes that the Legislature and the Shumlin
Administration follow through with policy changes and increased funding for the
state's drug monitoring system.